Health Wonk Review - The Election Is Over Edition
If you’re wondering what to do with yourself now that the election is over and you can’t listen to pundits debate the finer points of political campaigning, the Health Wonk Review is here to entertain and educate. Not surprisingly, a good number of posts this week dealt with the possibilities for health care reform under in an Obama administration. But before we get into the various ideas people have presented, I wanted to start things off with an article that I found fascinating, insightful, and timely. Disconnect, written by Annie at Home Of The Brave, will give you a peek into the world of poverty, loyalty, and what it’s really like to have no money and no access to health care in the wealthiest nation on earth. I grew up in Appalachia, and Annie’s article struck a cord with me. We often write about “the uninsured” and “those who cannot afford health care” but Annie has put a face on the problem. She also rightly points out that nurses are not typically invited to be involved in health care reform, even though they are on the front lines of health care delivery.
So how exactly will health care reform fare under our new administration? Read on…
At BNET Healthcare, David Hamilton writes about how health care reform could get a major kick start with Obama and the Democrats in congress. He makes some excellent points about how the economic and political environment are quite a bit different than they were in the 90s when the Clintons tried to tackle health care reform. And of course premiums have outpaced inflation ever since, which makes paying for health insurance much more of a struggle for the average person than it was in 1994. And David has a suggestion that would help make health care reform a reality: “A clever political strategy might package healthcare reform both as stimulus and as a necessary safety net for the millions of Americans likely to lose their jobs — and their employer-provided healthcare — if the economy does slide into the major recession many forecasters predict“.
Anthony Write from Health Access WeBlog is also optimistic about the prospects for meaningful health care reform following Obama’s win last week. He writes “Finally, we now have the ability to pursue reform not just at the state, but federal level. And for those of us committed to state-level reforms, it looks like we will have a partner, rather than an obstacle, at the federal level.” And I think this is key. Fifty different versions of health care reform and health insurance regulation is just too complicated. Especially with a nation as mobile as we are - people don’t stay in one state all their lives - we need some sort of federal intervention to make health care accessible to everyone, regardless of where they live.
The Health Affairs blog has written a two part entry on health care reform under the new administration. John Inglehart has an article about how Obama and his team will not repeat the mistakes of the Clinton health care reform effort, and Jeff Goldsmith presents three scenarios for health care reform under Obama and the Democratic congress. However you look at the situation, it does seem that Obama and his counterparts in congress will take some sort of action next year at addressing what was one of his most substantial campaign platforms - and just because of the name Jeff gave it (and because I think the administration is going to have to be creative in funding health care reform), I’m going to pick Braveheart.
Len Nichols at New Health Dialog has an article reminding us that whatever health care reform proposals end up on the table, they have to work for everyone, not just the red states or the blue states. While Obama did win a landslide electoral victory, the popular vote was about 66 million to 58 million. That’s a significant win, but it does leave a very large group of people who aren’t on board with the reforms that Obama has been proposing. And Len also reminds us that Bill Clinton had a tidy Democratic majority in congress back in the early 90s when he tried to reform health care. So whatever happens, a bipartisan approach will be key.
Brady Augustine of Medicaid Front Page takes a cautiously optimistic view of the future of health care - predicting rapid changes, but on a smaller scale than some might expect. He’s predicting increases in funding for SCHIP and Medicaid, both of which would have an impact on the number of uninsured Americans, and would be a good stepping stone towards major health care reform further down the road. And there’s a good picture of an elephant tipping over a van, so go check out the article.
Dr. Rich at the Covert Rationing Blog writes about the future of health insurance companies under an Obama administration coupled with the struggling economy. It makes sense to envision a government bailout of health insurance. If it could happen to a giant like AIG, what makes us think it couldn’t happen to our health insurance industry too? Let’s just hope that the executives in the health insurance industry (and the auto makers and any other industry that could be the recipient of government intervention) heed the mistakes of the banking industry, and cut the ropes on the golden parachutes if it gets to that point.
Health insurance reform is absolutely needed, but let’s remember that health care costs are what drive health insurance costs. On that note, let’s take a look at some of the factors driving health care costs:
Maggie Mahar, writing at Health Beat Blog, provides a very convincing argument about why the overuse of technology is driving health care costs. She notes that “… the major factor behind health care inflation is our inefficient use of advanced medical technologies. Too often we use them on patients who won’t benefit. And often, we use the newest, most expensive thing when something that already exists and is much cheaper, would be just as effective“. While innovation in health care has led to many life-saving breakthroughs, Maggie points out that ” ’selective’ medical care—delivering the right care, to the right patient at the right time—will not only save money, it will also save lives”. Well said - hopefully doctors and patients are listening.
Writing at Managed Care Matters, Joe Paduda is predicting more health care cost increases as an unwelcome side dish to accompany our various economic woes. Sadly, his analysis makes perfect sense: Everyone is tightening their belts, including employers who provide health insurance for most Americans. As businesses cut jobs and/or benefits, more people will find themselves without health insurance. But they will still need health care, and caring for those who are unable to pay for services drives up the cost of care for everyone. And of course people watching their friends and family get laid off are more likely to “stock up” on health care while they still have health insurance of their own (filling prescriptions, scheduling doctor visits they had been postponing, etc.). However we look at it, it’s likely that health care costs are only headed upwards.
The $700 billion price tag on the banking industry bailout had jaws dropping all over the place. But what if you found out that the US health care industry wastes that same amount every year in unnecessary medical tests and procedures that don’t improve patient outcomes? Check out the article by Jason Shafrin at Healthcare Economist regarding this issue. He presents not only the findings from the Progressive Policy Institute report, but also some possible solutions.
Speaking of costs, Jaan Sidorov at Disease Management Car Blog has an article about health care technology and costs. Jaan dissects Professor Paul Ginsberg and the Robert Wood Johnson Foundation’s views on technology and its place in health care, and offers up some insights on why technology is driving the cost of health care.
David Harlow from Health Blawg interviewed Don Berwick, CEO of the Institute for Healthcare Improvement about ways to reduce costs and increase efficiency in health care. Berwick has been calling for electronic health records for decades, and estimates that 30% of the costs in the American health care system are “pure waste”. I can get on board with the idea that “the U.S.needs to join the rest of the industrialized world and recognize health care as a right.” The genuine adoption of this belief would put health care reform in this country on the fast track.
Sam Solomon, writing at Canadian Medicine, discusses Ireland’s recent decision to discontinue subsidizing HPV vaccinations, and the debate on that issue that is currently going on in Canada. In tough economic times, tough decisions get made. There’s debate about prevention versus cure, and of course the HPV vaccine has not been without controversy even without the issue of who will pay for it. This could get interesting in other countries as well.
Brian Klepper and David Kibbe from The Health Care Blog are calling on health plans to re-empower the primary care physician. Their article highlights the cost saving measures that are realized when PCPs are more prevalent (as they are in other countries with lower health care costs than the US), and how our system dominated by specialists is inherently more expensive and wasteful. I agree, and have written about this subject several times. But there are some other interesting viewpoints presented in the comments - check it out and see what you think. Do you have a bias against PCPs when it comes to your own health? In my family’s experience, we went directly to a high level orthopedic surgeon when Jay injured his knee, but we chose a family practice doctor - instead of a pediatrician - to be our son’s doctor. So I guess we see it both ways.
Staying on the topic of PCPs, Vince Kuraitis at e-Care Management Blog paints a picture of a happy barbeque involving a group of new PCPs who have recently moved into a neighborhood and are meeting their new neighbors - employers, specialists, health insurance plans, disease management folks, and hospitals. Of course everyone gets along merrily face to face, but Vince shows us what’s going on behind the scenes after everyone goes home, and makes some telling points about why our health care system is a bit disjointed. It seems that not everyone is on the same page, and individual greed and mistrust might be overshadowing the best interest of the overall population.
And rounding out the HWR, we have frozen embryos, high risk pool health insurance, CEO fraud, and a possible pick to head the SEC:
Jon Coppelman at Workers Comp Insider has written a must-read article about Arkansas, workers comp, and a frozen embryo. Go read it and see what you think. With the question of when life begins is a hotly debated one - even appearing on the ballot here in Colorado last week - I imagine everyone will have an opinion one way or the other.
Hank Stern at InsureBlog has picked over the details of the new high risk pool health insurance policy in North Carolina. The plan is very new, and it remains to be seen how it will perform long term, but Hank has found some areas where it may struggle to contain costs. We’re lucky here in Colorado to have a successful high risk pool, but I know that many states have had to close their risk pools to new applicants because of funding issues. So Hank’s concerns are valid, and one would hope that NC had learned from the mistakes and successes of other states.
At Health Care Renewal, Roy Poses writes about the conviction of Lance Poulsen, founder and CEO of National Century Financial Enterprises, on fraud charges that read like a mobster’s rap sheet: money laundering, securities fraud, and wire fraud. The company had been in the business of buying debt from medical providers, and then selling the debt to investors. But it turns out that Mr. Poulsen wasn’t really on the up and up. Roy states - and I agree - that “…this case argues why we need more transparency, accountability, and commitment to ethical principles in the governance of health care organizations. More specifically, and as I have argued before, this case suggests the need for developing a licensure process for leaders of health care organizations.”
Eric Turkewitz from New York Personal Injury Law Blog gives us a heads up that Eric Dinallo may be picked to head the SEC under Obama. Dinallo is currently the superintendent of insurance in NY, and has a task force in place to determine what should be done about medical malpractice insurance rates in his state (which apparently increased by 14% recently). His perspective from the insurance industry side of things will be interesting to watch if he does get appointed.
Now go take down the sign from your yard, and turn off the talk radio. We should have at least a few months before the mid term election campaigns heat up.
Thanks for the rather comprehensive analysis with so many useful links. I was recently at the Physicians For A National Health Plan annual meeting. One of the most powerful presenters was Michael Lighty, director of administration and public policy for the CNA. Nurses get it. You might find the following op-ed interesting:
A Chance to Begin From Scratch:
Why The Economic Crisis Makes Fundamental Health Care Reform Possible
Aaron M. Roland, M.D.
In the face of an economic crisis of a magnitude unprecedented in more than half a century, pundits are already asking how President-elect Obama will alter his ambitious proposals. The implication is that economic hardship must inevitably lead to budget tightening, scaling back, and even abandonment of the change upon which he had based his campaign.
Certainly, people faced with job insecurity,collapsing investments, shrinking retirement accounts, and declining home values will tighten their belts. And in the face of changing conditions, the new President will have to reconsider his plans.
But in the case of health care, the crisis may have an unexpected effect. It may allow Obama move beyond his modest incremental proposals to something far more comprehensive.
Obama’s existing health care proposals argue for more tightly regulating insurance companies, expanding employer-based health insurance, and opening the Federal employee health program to all citizens. But by even the most optimistic estimates this complex plan will lead to coverage of only about 50% of those currently uninsured and will entail a cost of up to $1 trillion over the next ten years. In a world of $700 billion dollar bank bailouts, this may not sound like much, but in an economic environment where need is widespread, alternatives should be considered.
As recently as August the President-elect offered his own support for an alternative. “If I were designing a system from scratch,” he offered, “I would probably go ahead with a single-payer system.” The rationale for this idea is simple. The current private insurance based health care system has become a bureaucratic nightmare of buck-passing and profiteering. It is rife with waste that has nothing to do with providing quality comprehensive health care. Eliminate the source of that waste and spend it on health care.
Now, only some 65% of private health insurance premiums are spent on health care. Instead, insurance company executives earn hundreds of millions of dollars while corporate marketing departments spend fortunes selling insurance to the healthy just as their utilization departments resist paying for the care of those who become ill.
On the other hand, Medicare, with centralized funding and near universal enrollment of the population it serves, provides better quality care and higher satisfaction at a substantially lower cost than the private health system. Medicare’s bureaucracy takes up only 3% of its funding. No surprise as there are no resources spent on avoiding care for the sick, marketing, underwriting, investor relations, or corporate profits.
The economic crisis offers the new President the opportunity most other reformers have not had—the chance to begin from scratch. The American people have voiced an overwhelming desire for dramatic change. We have come to understand that business as usual isn’t always good business and that the business models that private systems create don’t always work in the public interest. Perhaps most importantly, however, the economic crisis has sensitized us to the need to pay attention to our money.
As a doctor in the trenches of primary care and as a small businessman, I can see no other way forward. For my well-insured patients, a switch to Medicare for all will hardly alter the face of the health care system they currently experience. But it will reduce everyone’s level of economic and health insecurity. None will need to worry if something is covered. There will be no more holding on to unsatisfactory jobs simply to keep insured. The process of paying for care will be simplified.
This is not socialized medicine, but a plan for public finance of our diversified private health care delivery system. An improved Medicare for all offers relief from the waste in the bureaucratic private health care system. It can eliminate a multitude of public and private programs which currently pay for segmented components of health care, eliminate the distinction between health care for the poor and for the rich, and reduce the confusion, waste, and annoyance which providers and patients face in dealing with the 1300 health insurance companies which litter the existing health care landscape
Politics, and political change, has been described as the art of the possible. Remarkably, the crises we face have made the seemingly impossible happen. We have a new President, a man who has inspired our hope. For our health let us begin from scratch. Let crisis and hope lead to real change.
Copyright November 5, 2008
Aaron Roland is a practicing family physician and clinical associate professor at U.C.S.F.
WoW, Louise, a tremendous job! It’s obvious that you read each of these posts. Kudos!
Thanks for hosting, and for including our post.
Stopping the HPV vaccine in Canada will be a big mistake, it is one of the STIs that is preventable by vaccination and everyone of those horrific things we can get off the streets we should.
Thanks for shearing details with us about who is working well to get remarks and makeover for damages in personal injuries cases.
I’m glad to see another article about why insurance premiums are going up. I think that if the government gets involved with controlling cost they need to start with the people who are over charging for health care and health maintenance i.e. prescription drugs. The next few years are going to be interesting.